D.C. Mun. Regs. tit. 29, r. 29-4500

Current through Register Vol. 71, No. 49, December 6, 2024

Rule 29-4500 - GENERAL PROVISIONS

4500.1

The rules set forth in this chapter establish the conditions of participation for a Federally Qualified Health Center (FQHC) in the Medicaid program. These rules also establish the reimbursement methodology for services rendered to Medicaid beneficiaries by an FQHC.

4500.2

Prior to seeking Medicaid reimbursement each FQHC must:

(a) Be approved by the federal Health Resources Services Administration (HRSA) and meet the requirements set forth in the applicable provisions of Title XVIII of the Social Security Act and implementing regulations, which shall include but not be limited to meeting the requirements governing federal approval of FQHC Look-Alikes;

(b) Be screened and enrolled in the Medicaid program pursuant to the requirements set forth in Chapter 94 of Title 29 of the District of Columbia Municipal Regulations; and

(c) Obtain a National Provider Identifier (NPI) for each site operated by an FQHC.

(d) Submit the FQHC's Scope of Project approved by the federal Health Resources Services Administration (HRSA).

4500.3

Medicaid reimbursable services provided by an FQHC shall be consistent with the Section 1905(a)(2) of the Social Security Act and furnished in accordance with Section 4231 of the State Medicaid Manual.

4500.4

Services may be provided at other sites including mobile vans, intermittent sites such as a homeless shelter, a seasonal site, or a beneficiary's place of residence, provided the claims for reimbursement are consistent with the services covered under Section 1905(a)(2) of the Social Security Act and described in Sections 4502 and 4505 - 4508.

4500.5

All services provided by an FQHC shall be subject to quality standards, measures and guidelines established by National Committee for Quality Assurance (NCQA), HRSA, CMS and the Department of Health Care Finance (DHCF).

4500.6

Services for which an FQHC seeks Medicaid reimbursement pursuant to this Chapter shall be delivered in accordance with the corresponding standards for service delivery, as described in relevant sections of the District of Columbia State Plan for Medical Assistance and implementing regulations.

D.C. Mun. Regs. tit. 29, r. 29-4500

Final Rulemaking published at 64 DCR 907 (2/2/2018)